HHS health rules no balm for states

The trepidation from states like Washington and Nevada gives credence to complaints — often chalked up as political — by Republican governors who have pleaded for clarity on the law. Some, like Oklahoma Gov. Mary Fallin, have said participating in an exchange would be irresponsible without more information.

But even among the states that have refused to build their own exchanges — instead either partnering with Washington or allowing the federal government to build one for them — there’s no less frustration among commissioners about what they say is a dearth of guidance.

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“I think there’s frustration on everybody’s part because [HHS officials] don’t know exactly where they’re going sometimes even though they’re supposed to guide us,” said South Dakota Insurance Director Merle Scheiber. “Lines of communication are open, but it doesn’t seem like anything gets solved.”

Another GOP commissioner grew visibly frustrated when asked whether he had been talking with HHS about the contours of a federal exchange.

“We’re not having the conversation because we don’t know what the answers are,” the GOP commissioner said.

HHS did not respond to a request for comment.

Other commissioners were more deferential to the administration, describing ample communication and little worry about meeting deadlines.

Nebraska Insurance Director Bruce Ramge, who had been preparing to run a state-based exchange until Gov. Dave Heineman shot it down earlier last month, described regular conversations with HHS and its Center for Consumer Information and Insurance Oversight. Now, he said he’s focused on smooth implementation of a federal exchange.

Iowa Insurance Commissioner Susan Voss, similarly said a trickle of regulations from the administration was beginning to answer states’ outstanding questions. And Hawaii’s insurance commissioner, Gordon Ito, reported no concerns about his state’s ability to operate an exchange on time.